Provider Demographics
NPI:1356389175
Name:DELEEUW, PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:DELEEUW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:DELEEUW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14988 BONAIRE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-1898
Mailing Address - Country:US
Mailing Address - Phone:239-481-1384
Mailing Address - Fax:
Practice Address - Street 1:14988 BONAIRE CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-1898
Practice Address - Country:US
Practice Address - Phone:239-481-1384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 27667207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95628YMedicare ID - Type Unspecified
FLD63545Medicare UPIN